ziggy29
Moderator Emeritus
Have you compared prescription drug prices? The U.S. is, to some degree, subsidizing the rest of the world for the R&D for new drugs.That's meaningful, but I'm trying to explain 50%.
Have you compared prescription drug prices? The U.S. is, to some degree, subsidizing the rest of the world for the R&D for new drugs.That's meaningful, but I'm trying to explain 50%.
but I'm trying to explain 50%.
(Qualifing Dr. Frist is ex-senate majority leader Repblican, and a heart surgeon.)
Given that we eat too much, and don't exercise enough, are we going to see a system that forces diet and exercise?
While this may seem far fetched to some, I don't think it is. We already have laws on the books that are justified by 'We all may have to pay if you are in an accident and don't have a seat belt on'. The same logic is used to support helmet laws and a slew of OSHA regulations. So it does not seem too far fetched that we will see lawmakers crafting some form of tax or law for the good of us all.
After all if you are over weight 'We all have to pay your bill'.
It's pretty clear there's increasingly a "war" on fat people going on today, and increased public funding exposure to health issues will only make that worse. I think fat people and smokers are the only two classes of people against whom bigotry and discrimination are still socially acceptable.
But I've made up my mind that the next time some old fat dude looks at me and says "wow, you're tall", I'm going to look right at his big gut and say "wow, you're fat". Wonder how that will go over?
Sure, they are. No quarrel at all with that. But in my experience, usually in terms of discussing public policy it's less about genuine concern about health and more about "you're costing me money" or "I'm subsidizing you." (I'm not saying that's you, but it's common in discourse about public health. The post you replied to was directly after yours but it wasn't yours in particular I was aiming at. Hope that's clear.)I'm sorry you feel like a war has been declared on "fat" people and smokers. Truly I am. But I have to wonder why do you think pointing out the health risks of obesity and smoking is bigotry and discrimination? Those behaviors are risky to one's health.
By the way: When someone asks you that, the proper response is to spit on them and tell them it's raining.Not exactly the same thing (but close), but as a woman who is 6' tall, I've never met anyone who didn't have something to say about my height, and have heard ... "how's the weather up there" more times than I can count.
By the way: When someone asks you that, the proper response is to spit on them and tell them it's raining.
Have you compared prescription drug prices? The U.S. is, to some degree, subsidizing the rest of the world for the R&D for new drugs.
All true, plus significantly/ironically, excessive usage by those who have health care insurance. My MegaCorp provides great benefits and most of our employees overuse them because they pay so little of the cost. Just a few examples:Things that make our US healthcare so expensive
lifestyle (obesity, smoking, drugs)
high cost and profit for intermediaries (insurance)
excessive profit for some product and service providers
administrative burden (millions of microplans)
high charges for specialized services
forced use of expensive specialized facilities for routine medical needs (emergency room)
multiple regulations around the country
punitive legal awards
diagnostic overuse (expensive tests even for routine matters)
treatment overuse (especially end of life)
excessive unproductive labor vs technology
Things that make our US healthcare so expensive
lifestyle (obesity, smoking, drugs)
high cost and profit for intermediaries (insurance)
excessive profit for some product and service providers
administrative burden (millions of microplans)
high charges for specialized services
forced use of expensive specialized facilities for routine medical needs (emergency room)
multiple regulations around the country
punitive legal awards
diagnostic overuse (expensive tests even for routine matters)
treatment overuse (especially end of life)
excessive unproductive labor vs technology
Our current dysfunctional approach to healthcare has evolved over decades, driven by a unique combination of medical and financial motivations. It is both quite good and quite bad.
“Comprehensive healthcare reform” is going to take a long time. The ideological and financial interests today are well entrenched. Starting with high upfront costs in the midst of a recession – well, it’s a hard sell. The version they’re considering now makes more sense.
Excellent list.
Googling a little, I get a number of references for end-of-life care as 10-12% of total medical spending. This includes all the expenses in the last 12 months of life, regardless of the prognosis at the time (i.e. some of this money was spent on people who the doctor expected would live). If you focus on just Medicare, it's more like 25%. I don't have a comparable number for other countries.
I think that "treatment overuse" is prevelant in other situations. Someone with a painful knee and insurance in the US can get an MRI within a day or two. Maybe the MRI doesn't turn up anything, the knee would have recovered on its own, and the MRI was "wasted". I've had physical therapy for injuries a couple times in the last two years. In both cases, the first session was the most important as I found out what was wrong and got some DIY exercises. Later sessions probably helped it heal sooner, but they cost fellow-insured's a chunk of money.
I think the reason we don't attack most of the things on the list is that most Americans don't know how much they are spending for medical care. Some say "The insurance company pays for it". Others think a little further and say "My employer pays for it", and never stop to think that this is money that could/should have been in their paycheck. For others "The gov't pays for it". We do a great job of hiding the cost of gov't programs. Most workers can see the Medicare tax of 1.45% of wages. They don't realize that's only 25% of the total taxpayer subsidy of Medicare. So the actual cost 4 times what they see.
If I were doing healthcare reform, I'd push to make sure that people can see the full cost of medical care. Make sure that all Federal funding comes from a single, visible, named tax. Eliminate the tax deduction for employer-paid health insurance. I think the only way we will make good decisions on medical expenses is if people can see both sides of the cost/benefit decision.
I have always thought that one of the problems i.e. things that cost more, is the number of Hospitals that compete for business. Now normally you would think competition would lower cost, but with every hospital 'having' to have all the modern equipment and them under using it, cost goes up. I guess a way to look at it is there is some very expensive equipment siting idle and not making money.
Something I haven't seen addressed here is how the plans taking shape in Washington will effect those of us without subsidized health insurance who plan to retire early, or who have already retired early. The various plans seem to include a few basic principals 1) Mandates that every individual buy insurance 2) No "pre-existing condition" exclusions 3) subsidies for lower income families.
At least one consequence of these provisions seems pretty obvious to me. Areas of the country where individual health insurance is currently cheap may become much more expensive because of the requirement to insure "pre-existing conditions". Some of that increase may be offset by the individual mandate, but my guess is we'll see rates in cheap areas rise and rates in expensive areas fall.
.... health care costs in McAllen are twice that of comparable cities while health outcomes are no different. The reasons are complex but probably because good physicians are ordering lots of tests, calling in lots of consultants, making good use of the equipment they own and the imaging centers they might have a stake in (and yes, they think they can be objective in ordering an MRI or CAT scan that sends the patient to their own facility); it has to do with hospitals competing with each other for the kinds of patients with conditions that are reimbursed well, and wooing patients, wooing high-volume physicians (some of whom are invited to invest in the hospital) to make full use of their PET scan, their gamma knife, their robotic-surgery facility, their cancer center, their birthing center. That was Atul Gawande’s conclusion, and I would concur.
But I’d like to officially let McAllen off the hook and say that having practiced in five states, including 15 years in the great state of Texas, we are all complicit in practicing just that kind of medicine if you look hard enough and if you looked at us individually. Conflicts of interest are rife; they are almost the rule. So is the ability to wear blinders so we are (mostly) oblivious to our conflict.
Now you can reduce the probability of a heart attack by swallowing a statin, and it will make good sense for you personally, especially if you have other risk factors (male sex, smoking etc).. But if you are treating a population, keep in mind that you may have to treat several hundred people to prevent one heart attack. Using a statin costs about $150,000 for every year of life it saves in men, and even more in women (since their heart-attack risk is lower)—I don’t see the savings there
I'd take it a step further. You need to see it and be on the hook for part of it. I'd say on a good day less then 25% of the patients I see in the ED need to be seen and evaluated there. Without a financial penalty to be there they will continue to over utilize the ED.
DD